Uncommon Presentations of Ectopic Pregnancy

Abstract

Abstract:

An ectopic pregnancy is classically thought of as an extrauterine pregnancy that implants within a fallopian tube. However, 5% of ectopic pregnancies are nontubal in origin. This article reviews 3 uncommon presentations of ectopic pregnancy, including cesarean-scar, cervical, and interstitial pregnancies. Literature related to the 3 aforementioned uncommon sites of ectopic pregnancy was reviewed using PubMed. Historically, nontubal ectopic pregnancies were associated with higher morbidity and mortality due to late diagnosis. However, earlier diagnosis is possible with advancements in imaging technology and high sensitivity ß-human chorionic gonadotropin enabling the development of conservative treatment approaches. For all 3 of these uncommon presentations, ultrasonography is most commonly used for diagnosis. As with tubal ectopic pregnancies, management can include medical or surgical approaches. Expectant management is generally not recommended. Success rates of conservative management are generally quite high, and there is a low number of complications. Cesarean-scar, cervical, and interstitial pregnancies are rare forms of ectopic pregnancy and can result in high morbidity and mortality if not diagnosed early. Thus, providers should have a high level of suspicion for these uncommon presentations, especially in patients with risk factors, so that early diagnosis and conservative management can be achieved. (J GYNECOL SURG 38:185)